To test empirically whether utilizing a narrative format (compared to a non-narrative format) might produce a stronger and more sustained impact on knowledge, attitudes and prevention behavior, my colleagues, Lourdes-Baezconde-Garbanati, Doe Mayer, Jeremy Kagan, and I produced two short films each 11 minutes in length and both containing the same 10 facts regarding cervical cancer prevention, detection and treatment. Tamale Lesson conveys facts regarding the cause of cervical cancer, as well as how to prevent it (via the HPV vaccine) and detect it (via Pap tests) using a Mexican American family’s preparation for their youngest daughter’s Quinceañera or 15th birthday as the narrative vehicle. The non-narrative film, It’s Time, contains the same facts but uses a more traditional approach featuring doctors, patients, facts and figures.

The relative efficacy of these two films was tested by first surveying 1000 randomly selected women (300 African American, 300 European American, 300 Mexican American and 100 Korean American) to establish a pretest baseline level of cervical cancer-related knowledge, attitudes and behavior, randomly assigning these same women to receive either the narrative or non-narrative film and then resurveying them two weeks and then six months later. The results of this large-scale quasi-experimental study revealed that the narrative was indeed more effective in increasing cervical cancer-related knowledge, attitudes and increasing actual cervical cancer screening rates by the six-month follow-up. Moreover, the six-month follow-up data revealed that the narrative virtually erased the ethnic disparity in cervical cancer screening rates that existed at baseline (where the European American women in our sample were far more likely to have been recently screened (42%) than Mexican American respondents (27%). By the six-month follow-up Mexican American respondents exposed to the narrative went from having the lowest rate of screening to the highest (from 27% to 80%). This suggests that narrative formats may provide an invaluable and underutilized tool in reducing health disparities.

In addition, we examined how the effect of a narrative can be moderated by key demographic factors such as age, income and ethnicity as well as more theoretical factors such as identification with specific characters and feeling “transported” or engrossed in the narrative. Regressions revealed that transportation, identification with specific characters, and emotion contributed to shifts in knowledge, attitudes, and intent to be screened for cervical cancer. These results call for a re-examination of the prevailing “one-size-fits all” assumption that describes most health messages. The theoretical and practical implications of this research will be discussed.